Soft-Tissue and Osseous Impingement Syndromes of the Ankle: Role of Imaging in Diagnosis and Management

Abstract

Soft-tissue and osseous impingement syndromes of the ankle can be an important cause of chronic pain, particularly in the professional athlete. The main impingement syndromes are anterolateral, anterior, anteromedial, and posterior impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performed and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging, but the accuracy and role of MR imaging in assessment of possible ankle impingement have not been clearly established. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes.

Ultrasonography in the Assessment of Lateral Ankle Ligament Injury, Instability, and Anterior Ankle Impingement: A Diagnostic Case Report

“…Osteophytosis and synovitis are known sequelae of chronic ankle injury and, if present anteriorly, may provoke impingement, characterized by limitation in dorsiflexion with concurrent pain at end range. 5 In this case, US successfully demonstrated multiple ligament injuries with joint laxity and ankle degeneration with subsequent bony impingement providing important information with regard to ankle function and circumventing more expensive imaging such as MRI. Although conflicting reports exist describing the diagnostic accuracy of US in diagnosing anterolateral ankle impingement, 10,11 there is understandably high interest to continue to explore the utility of US in diagnosing impingement syndromes around the ankle.…”

“…5 Recurrent injury, long-term ligament laxity and subsequent joint instability lead to the development of abnormal osseous and soft tissue thickening causing impingement syndromes of the ankle. 5 Mechanical instability, often seen after inversion ankle injuries, is connected to the anatomic abnormalities of the ankle and related to ligament laxity. 9 Functional instability relates to posture, muscle, and proprioceptive deficits, and is also commonly associated with inversion injuries.…”

“…4 Furthermore, a combination of tibiotalar osteophytes and surrounding synovitis may produce anterior ankle impingement, a condition characterized by limitations with dorsiflexion and concurrent pain. 5 Inversion ankle injuries should be thoroughly examined so that appropriate diagnosis and treatment can be provided to avoid recurrent injury and obviate ankle joint osteoarthritis. Ultrasonography (US) is useful in evaluating the lateral ankle ligaments as it provides high resolution of ligament anatomy and pathology.…”

Stieda process versus Haglund’s deformity: An uncommon presentation of posterior ankle impingement

“…Posterior ankle impingement syndromes include a variety of abnormalities that lead to compression of the soft tissues between the talus, the calcaneus and the posterior tibia on plantar flexion of the ankle [1][2][3][4][5][6].…”

“…Ankle impingement syndromes can be an important cause of chronic ankle pain, which can negatively influence the performance of professional athletes [1]. Biomechanically they are caused by friction between joint tissues and they are characterized by limitation of full range of ankle motion due to osseous and soft tissue abnormalities [2].…”